Another critical post-transplant maintenance issue is the duration of therapy, and both faculty treat indefinitely or until disease progression, the same strategy used in the CALGB-100104 trial that demonstrated a survival benefit with lenalidomide maintenance. Our survey indicates that only about half of oncologists use indefinite maintenance, with the others stopping therapy after 1 to 2 years. Several Phase III trials are evaluating limited-duration versus indefinite treatment, including ECOG-E1A11. Dr Munshi notes that studies of defined duration usually demonstrate an increase in relapses from the time treatment is discontinued.

Benboubker L et al. Lenalidomide and dexamethasone in transplant-ineligible patients with myeloma. N Engl J Med 2014;371(10):906-17. Abstract

McCarthy P et al. Lenalidomide after stem-cell transplantation for multiple myeloma. N Engl J Med 2012;366(19):1770-81. Abstract

Palumbo A et al. Continuous lenalidomide treatment for newly diagnosed multiple myeloma. N Engl J Med 2012;366(19):1759-69. Abstract